In one of the most promising developments in more than 20 years, scientists claim that drugs used to control HIV/AIDS in patients may also be effective in preventing the disease in the first place.

The drugs in question are tenofovir (Viread) and emtricitabine, or FTC (Emtriva), sold in combination as Truvada by Gilead Sciences Inc. Gilead is the California company best known for inventing Tamiflu.

Previous research has been aimed at finding a vaccine against HIV/AIDS, with the intention of conditioning the immune system against the disease. But these drugs work differently. They simply keep the virus from reproducing, and have already been used successfuly by health care workers to prevent them from being infected by the virus carried by patients.

This approach to fighting HIV/AIDS has been tempting researchers for many years, but has only recently become feasible as preventative drugs have been developed that are safe for non-infected persons to take. Previous drugs had unreasonable effects for uninfected persons.
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Introduction

The first cases of acquired immune deficiency syndrome (AIDS) were reported in the U.S. in June of 1981. The occurrence of the syndrome among homosexual men, intravenous (IV) drug abusers and, later, blood transfusion recipients and persons with hemophilia suggested a transmissible agent as the cause. In 1984, scientists identified a retrovirus, human immune deficiency virus (HIV), also known as human T-Iymphotropic virus type III/lymphoadenopathy, associated virus (HTLV-III/LAV), as the primary cause of AIDS. In 1985, screening tests to detect antibodies to HIV were licensed, allowing identification of infected individuals and the screening of the blood supply. Researchers have been able to map the genetic structure of HIV and to demonstrate the nature of the immune defect. Ongoing research is aimed at identifying risk factors and preventive strategies, evaluating antiviral drugs, developing drugs to augment the immune system, and developing a vaccine.

An estimated 1,000,000 Americans have been infected by the HIV virus. The virus has been isolated from various bodily fluids including blood, semen, saliva, tears, urine, breast milk and cerebrospinal fluid. Transmission of HIV occurs primarily through four major routes: sexual contact, intravenous drug use, blood transfusions and perinatal contact with an infected mother. The screening of donated blood since 1985 for HIV antibodies has virtually eliminated blood transfusion as a risk for acquiring AIDS in the U.S. 95% of the cases of AIDS reported in the U.S. have belonged to the following high risk groups: homosexual and bisexual men, 73%; IV drug abusers, 17% (11% of homosexual and bisexual men also inject drugs); blood transfusion recipients, 2%; persons with blood clotting disorders or hemophilia, 1%; heterosexual contacts of persons in the above groups, 1%; and infants born to mothers with AIDS or HIV infection, 1%.

All persons with AIDS or with antibodies to HIV are considered carriers of the virus and capable of transmitting it to others. It is believed that most people with antibodies to HIV will remain free of AIDS symptoms. The ratio of persons infected with HIV to those with AIDS is estimated currently at between 100:1 to 50:1. The three-year incidence of AIDS among persons with the HIV infection ranges from 8% to 34.2% in selected municipal studies. Estimates are that 10% to 30% of infected persons will develop AIDS within 5 years. For persons who develop AIDS, the overall fatality rate in April of 1986 was 54%. At the end of two years following diagnosis of AIDS, however, the fatality rate was over 75%. At five years, the fatality rate was about 90%.

90% of AIDS patients are between 20-49 years of age. The loss of years of potential life before age 65 due to AIDS is nearly the same as for cancer in single men 25-44 years of age. The economic costs of AIDS are considerable, totalling an estimated $4.1 billion in 1985. Data cited here are changing rapidly and represent the situation only as of 1986.
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HIV is known as Human Immunodeficiency Virus. It is a sexually transmitted disease
and is highly contagious. It is a virus that can harm the body’s immune system. It is also the virus which causes AIDS.

HIV symptoms may be similar to flu-like symptoms like fever, muscle pain or aches, rashes and swollen glands. These symptoms may appear in about four weeks of exposure to HIV. Anyone who has hepatitis C should be tested for HIV. Those who have multiple sexual partners and having sex without protection should also undergo HIV testing. Those who share needles and syringes or are into drug abuse must be tested as well.

HIV testing is usually done in hospital, in private clinic or health centers. The doctor supervises the testing by taking samples of blood, saliva and urine from the patient. The patient has the option to take a rapid test of HIV testing. The results are known after about 30 minutes after the samples are analyzed. This is done in hospitals, HIV testing sites and private clinics. The results are interpreted and confirmed by the doctor.

One reliable rapid test is the enzyme-linked immunosorbent assay or the ELISA test. This test accurately detects the presence of anti-bodies to combat HIV. If there are anti-bodies present in the samples, then the patient is positive for HIV. If there is no detection of these, then the result is negative and the patient is not infected with HIV. This test has 99% accuracy.
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By any measure, AIDS is a frightening disease. It is physically devastating, incurable, and lethal. And it is spreading at a menacing pace. Fear and misconceptions about AIDS, however, have spread faster than the disease itself.

Federal health officials stress that the AIDS virus has spread almost exclusively by three routes: by sexual intercourse, through blood contact (contamination with or transfusion of infected blood or blood products), and from an infected pregnant woman to her fetus or newborn. The only other known instances in which the virus was transmitted, say officials, involved artificial insemination or organ transplants from infected donors.

But many people remain unconvinced. They fear that casual personal contact with an AIDS victim—a handshake, a sneeze, a drink from the same glass—might lead to infection. A child with AIDS attempting to attend school can throw a community into a frenzy. An AIDS patient returning to work may find coworkers deserting the job in protest.

In short, anxiety about AIDS has itself become epidemic. Part of the problem is that AIDS is a new disease—mysterious in its origin and initially baffling in its symptoms and cause. But the impression that scientists are groping amid a welter of unresolved questions is misleading. A vast amount of critical knowledge has already been gained about AIDS, and more is being learned all the time.

The epidemic first surfaced in the late 1970s, when rare cancers and uncommon infections began appearing in a number of gay (homosexual) men. Those illnesses were linked with a severe deficiency in the body’s immune-defense system—a disorder initially called GRID, for Gay-Related Immune Deficiency. As late as mid-1981, gay men were still the only known victims in the United States, creating the impression that AIDS arose from something exclusive to that group.

By 1982, when the name became AIDS, for “acquired immune deficiency syndrome,” the first currents of fear jolted the health-care community. The number of AIDS cases was rising geometrically, and the disease had appeared in two more groups—intravenous drug users and hemophiliacs. Not only did the pattern imply an infectious agent, but the disease was now affecting three of the principal groups vulnerable to hepatitis B infection—a viral illness that’s also an occupational hazard among health workers.
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Rock Hudson (died 1985) – Rock Hudson was an American actor who starred in many films and several TV programmes. He was well renowned for his role in romantic comedies and as a romantic leading man (often acting opposite Doris Day), playing of his masculine looks. He was voted ‘Star of the Year’, ‘Favourite Leading Man’ and many other roles and completed around 70 films over four decades making him something of a Carry Grant-type figure. It was ironic in a way then that for all this time he was hiding his homosexuality and would succumb to, and eventually die of, AIDS at the age of 60.

Kimberly Bergalis (died 1991) – Kimberly Bergalis is an unusual addition to this list as someone whose fame actually came from their experience with AIDS as someone who would become a pivotal symbol in the debate regarding AIDS testing for health professionals. With no celebrity status before her debacle, it was a tragic way to acquire fame.

As the eldest of three daughters, Bergalis was born in 1978 and attended the University of Florida to major in business. Here she had two serious boyfriends but never lost her virginity and had never used any kind of drugs. In 1987 she had two molars removed by her dentist Dr David J Acer. Tragically, Dr Acer had been diagnosed with AIDS that year and shortly after Bergalis began to show symptoms herself. CDC tests suggested that it was Acer who infected Bergalis and several of his other patients. HIV can spread from patient to doctor, doctor to patient or even patient to patient via reusing unsterilized instruments (scalpels, hypodermic needles etc). Today almost all such instruments are disposable.
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